Diagnosis and management of prenatally detected myelomeningocele: A preliminary report

Hogge, W. Allen; Dungan, J.S.; Brooks, Mark P.; Dilks, Susan A.; Abbitt, Patricia L.; Thiagarajah, Siva; Ferguson, James

doi:10.1016/0002-9378(90)91127-x

Cited by 24 publications

(5 citation statements)

References 6 publications

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“…The functional prognosis for ambulation and sphincter control in patients with my elomeningocele is variable and dependent, in part, on the extent of the spinal neurological deficit [8], The level of spinal column dysraphism can be determined by prenatal ultra sound examinations [3,9] and is an indicator of the anatomical extent of the cord malfor mation [10].…”

Section: Introductionmentioning

confidence: 99%

Prenatal Spinal Evaluation and Functional Outcome of Patients Born with Myelomeningocele: Information for Improved Prenatal Counselling and Outcome Prediction

Cochrane¹,

Wilson

Steinbok³

et al. 1996

Fetal Diagn Ther

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Objective: Prenatal ultrasonography can localize the level of the spinal cord malformation, allowing prediction of the potential postnatal neurological deficit and functional prognosis. Methods: This study has two evaluations: (a) a retrospective prenatal review of 26 fetuses with spinal dysraphism (1987–1991), and (b) a follow-up descriptive study of patients (1971–1981) who underwent closure of the spinal lesion and ventricular shunting in the neonatal period. Results: Prenatal ultrasound evaluation enabled the accurate definition of the last intact vertebral level which allows separation of fetuses into three functional groups (last intact level L2, L3–4, L5–sacral). Patterns of ambulation, urinary and bowel continence, and school performance vary according to level of spinal lesion and the neurological deficit. The need for ventricular shunts, the incidence of other spinal malformations and surgical interventions did not vary with the level of the spinal lesion. Conclusions: The functional outcome for patients with myelomeningocele is variable; however, distinct patterns emerge based on the level of spinal dysraphism and the resultant neurological deficit. By relating the level of the fetal spinal lesion to outcome data, more precise functional prognoses can be given to families.

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Section: Introductionmentioning

confidence: 99%

Prenatal Spinal Evaluation and Functional Outcome of Patients Born with Myelomeningocele: Information for Improved Prenatal Counselling and Outcome Prediction

Cochrane¹,

Wilson

Steinbok³

et al. 1996

Fetal Diagn Ther

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“…Prenatal diagnosis of MMC has been improved through the combined use of maternal serum ␣-fetoprotein screening, ultrasonography, and amniocentesis, resulting in detection rates as high as 95% [Katz et al, 1991;Platt et al, 1992;Hogge et al, 1990]. The prenatal diagnosis of MMC allows the performance of further diagnostic studies such as high-resolution ultrasonography and ultrafast MRI, to define the level and extent of the spinal lesion.…”

Section: Patient Selectionmentioning

confidence: 99%

Prospects for fetal therapy of neural tube defects

Adzick

1998

Ment. Retard. Dev. Disabil. Res. Rev.

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“…Eleetive eesarean delivery for ehildren diagnosed with myelomeningoeele in utera has been assoeiated with benefits by some investigators (2,7,8), while others repOlt no differenee in outeome (1,3,6,15). Eleetive eesarean delivery for ehildren diagnosed with myelomeningoeele in utera has been assoeiated with benefits by some investigators (2,7,8), while others repOlt no differenee in outeome (1,3,6,15).…”

Section: Introductionmentioning

confidence: 99%

19-Year Follow-Up of Fetal Myelomeningocele Brought to Term

Liu

Shurtleff²,

Ellenbogen³

et al. 1999

Eur J Pediatr Surg

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We conducted a 19-year follow-up study of 223 infants with myelomeningocele born by cephalic presentation, 68 born by pre-rupture of amniotic membranes cesarean section (PRAM C/S) and 155 born vaginally to determine outcome. We recorded radiographic level as the last intact vertebral arch at the cephalad end of the spinal defect from standard AP films of the spine. Protrusions of the lesions dorsal to the back were obtained from medical records or parental recall. Subsequent spinal cord abnormalities (hydromyelia, tethered cord and hypoplasia) were determined by patient's symptoms and verified by MRI. Data were from our Patient Data Management System and analyzed using Microsoft Excel and Epi Info 6. Flat lesions protruding less than 1.0 cm beyond the plane of the back and those associated with breech position or kyphus were not benefited by PRAM CIS (Fisher's Exact, p = 0.58 between the two types of delivery for motor level). Flat lesions were more common in the vaginally delivered group (p = 0.01). Lesions protruding equal to 1.0 cm or beyond were associated with less paralysis after PRAM C/S (p = 0.01). Although tethered cord syndrome was more common in the PRAM C/S group (p = 0.02), there was no difference in the muscle strength loss between the PRAM C/S and the vaginally delivered groups. Symptomatic hydromyelia was equally distributed but spinal cord hypoplasia was more common in the PRAM C/S group (p = 0.03). Due to the limited numbers of patients in each group available for analysis, we recommend further study to ascertain the appropriate management of fetal myelomeningocele diagnosed in utero and brought to term.

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Diagnosis and management of prenatally detected myelomeningocele: A preliminary report

Cited by 24 publications

References 6 publications

Prenatal Spinal Evaluation and Functional Outcome of Patients Born with Myelomeningocele: Information for Improved Prenatal Counselling and Outcome Prediction

Prenatal Spinal Evaluation and Functional Outcome of Patients Born with Myelomeningocele: Information for Improved Prenatal Counselling and Outcome Prediction

Prospects for fetal therapy of neural tube defects

19-Year Follow-Up of Fetal Myelomeningocele Brought to Term

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